- Most common congenital deformities of the lower extremity with incidence 1-2 cases per 1000 live births
- Between six and twelve weeks of gestational age, the fetal foot assumes a clubfoot position
- Deformities include : hindfoot varus and equinus, forefoot adductus and midfoot cavus
- Talus has a short neck with medial and plantar deviation of the anterior end. Also the medial and anterior facets are underdeveloped.
- The Ponseti method is the most commonly used nonoperative method for the treatment of clubfoot
- Deformities are corrected in the order of the CAVE acronym (cavus, adductus, varus, and equinus). Cavus is corrected first by elevating the first metatarsal, and adductus deformity is corrected by rotating the forefoot and calcaneus under the fixed talus.
- Equinus is the hardest deformity to correct with casting and in most cases is treated with percutaneous Achilles tenotomy
- Soft tissue release is performed between 9 to 12 months of age after failed non operative treatment or when the deformity recurs after successful initial treatment
- It involves circumferential release of the subtalar joint and posterior capsule of the ankle joint with lengthening of the Achilles tendon, flexor tendons, and posterior tibialis tendon
- Adherence to night bracing after casting increases the success rate of the Ponseti method, and brace wear of more than 8 hours per day yields the highest success rate
